Driving the highway takes up to 3 hours, as it passes through rugged countryside. It climbs three saddles: the Strathmore Saddle, Whangamomona Saddle, and Tahora Saddle. 14 km past Whangamomona is the Moki Tunnel, also known as Hobbit's Hole. Near one end of the Moki Tunnel is the turn off for the Mount Damper Falls, the fourth-highest in the North Island, and past the other end is the Tangarakau Gorge, with walls just under 200 ft high.

12 km (7.5 mi) of the road through Tarangakau Gorge is unsealed. This makes State Highway 43 the only state highway that currently has an unsealed section. There is also an unsealed section in the middle of State Highway 38, but that portion is not designated a state highway. A 2017 report stated that sealing the Tangarakau Gorge road would cost approximately $7m.[1]

State Highway 43 has been ranked as one of the 10 worst roads in New Zealand by the Police.[2] The slippery gravel surface in the Tangarakau Gorge is the main cause of the highway's bad safety record. This section is not scheduled to be sealed, however, because of the low traffic volume. Some local residents have protested the condition of the unsealed road; in 2016 homemade signs proclaimed the road "closed".[3]